| NPI | 1285776377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249674) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5042) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-11-04 |